髂内动脉栓塞治疗骨盆骨折所致出血对男性性功能的长期影响和BIIAE的长期安全性

Influence on male sexual function and long-term safety of bilateral internal iliac artery embolization for the treatment of pelvic fractures inducing hemorrhage

目的探讨双侧髂内动脉栓塞(BIIAE)治疗骨盆骨折所致出血对男性性功能的长期影响和BIIAE的长期安全性。方法前瞻性选择18例因钝性骨盆骨折失血性休克接受BIIAE治疗的男性患者(BIIAE组);第1对照组为18例骨盆骨折但未接受血管造影栓塞患者(骨折未栓组),第2对照组为18例严重创伤但无骨盆骨折、脑及脊髓损伤患者(非骨折组)。各组用可能引起性功能损伤的危险因素(年龄、损伤后的时间、创伤严重程度评分,骨盆简略创伤分数、是否存在尿道损伤)进行1∶1匹配。外伤至少18个月后采用问卷调查表评估男性性功能。结果骨盆骨折后患者IIEF-5分数明显降低(P<0.05);BIIAE组和骨折未栓组的勃起障碍、维持勃起障碍发生比例较非骨折组明显增加(P<0.05);BIIAE组和骨折未栓组的性冲动、勃起功能以及性生活满意度分数较非骨折组明显降低(P<0.05)。BIIAE组与骨折未栓组患者之间无明显差异(各项比较,P均>0.05)。结论 BIIAE不会引起持久的骨盆缺血,骨盆骨折后的男性性功能障碍是创伤所致而非由BIIAE引起;BIIAE治疗骨盆骨折出血安全有效。

Objective To assess the influence on male sexual function and the long-term safety of bilateral internal iliac artery embolization（BIIAE）for the treatment of pelvic fractures inducing hemorrhage.Methods The study group（BIIAE group）was prospectively established and consisted of 18 patients who were treated with temporary BIIAE with gelatin particles for blunt pelvic fractures inducing hemorrhage.There were two control groups：One control group consisted of 18 patients with similar pelvic fractures but did not require embolization therapy（fracture group）;The other group consisted of 18 severe trauma patients without pelvic fractures,brain and spine injuries（non-fracture group）.The 3 groups were matched for risks factors of male sexual dysfunction,i.e.age,time after injury and injury severity score,and the BIIAE group and fracture group were matched for pelvic Abbreviated Injury Scale score and presence of urethral injuries.Subjects were evaluated at least 18 months after injury through a questionnaire which consisted of 18 items assessing urinary functions and male sexual functions.Results IIEF-5 scores significantly decreased since pelvic fractures.The incidences of male erectile dysfunction and erectile dysfunction of maintence in patients of BIIAE group and fracture group were higher than that in non-fracture group（P0.05）.Scores of sexual impulse,erectile function and sex life satisfactory degree in patients of BIIAE group and fracture group were lower than that in non-fracture group（P0.05）.There was no significant difference in sexual functions between BIIAE group and fracture group（all P0.05）.Conclusion BIIAE does not produce persistent pelvic ischemic injuries.Male sexual dysfunction after pelvic fracture caused by injuries,not by BIIAE.BIIAE is safe and effective for the treatment for pelvic fractures inducing hemorrhage.